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Declaration ot Don~icile and Citizenship
TO THE STATE ANO COUNTY TAX ASSESSOR,
Si. LUCIE COUNTY, FLORIDA:
Tfiis is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in aaordance and
in aonformity with Chapter 222, Section 222.17, Flo~ida Statutes.
I wns forme~ly a legal resident of ~t~it M3Chigan
(Ciry) (State) ~
12028 NStdO~l . Howevef 1 have c#~an ed m domitile }
and 1 resided at - 9 Y
(St~eet and Number)
to and am and have been a bona fide resident of the State of Florida since 6th day of
Nove~ber 4 69 ~ ~ resid~ ai_ _
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ree a um
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
a~ ihis statement is to be taken as my declaration of citizenship, actual legal residence and domicile in tFse State of Horida.
(Insert here any pertinent fects, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.) '
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$atabiishiag residence and applqing for hoaestesd
FILEO AND RECORDED ' !
ST. LUCIE COUNTY. FLA.
~~.co~n ~~..~,~~Fo
188146
'10 JA~# I 2 AM IQ : 4 I
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~ CLERKyCiRLUlT COURT
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~ I RIRTHER CfRTIFY that I will oomply with all other requirements of a legal resident of this State. '
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~ I FURTHER CERTIFY that 1 have no intention to retum to my former domiGle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently.
=;i', ~ s a U h r~. ' X ~/~4~~/ " ?
~ '~i~~ ~Y~ _
. . . c:~, : v . (Name)
Anna A~aYres
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~ ' '°'"~worn to and suburibed before me this 12 day of Januasy ~ 19 70
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' ROGER POITRAS
~ CIRCU COURT Notary Public
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Sy D.C. My Gommiuion expires
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~ Ro b~ ~x~cvt~d in dupliub snd ori~inal fil~d wkh CIKk CjrcuN Courl, and dupliea» with Tax A:s~aor.) ~
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~ ~ 13 600K~~~ PA~E 528 ~
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